Universität zu Köln

Vehreschild, Maria J. G. T., von Bergwelt-Baildon, Michael, Tran, Liliane, Shimabukuro-Vornhagen, Alexander ORCID: 0000-0002-2351-7294, Wisplinghoff, Hilmar, Bangard, Christopher, Cornely, Oliver Andreas and Vehreschild, Joerg Janne (2014). Feasibility and effectiveness of posaconazole prophylaxis in combination with micafungin bridging for patients undergoing allogeneic stem cell transplantation: A 6-yr analysis from the cologne cohort for neutropenic patients. Eur. J. Haematol., 93 (5). S. 400 - 407. HOBOKEN: WILEY. ISSN 1600-0609

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Abstract

IntroductionInvasive fungal diseases (IFDs) are an important cause of morbidity and mortality in patients undergoing allogeneic stem cell transplantation (SCT). MethodsTo compare the effectiveness of two prophylactic antifungal regimens used as standard of care (SOC) in the setting of SCT during the periods of May 2006 - September 2009 (oral posaconazole, POS) and October 2009 - July 2011 (oral posaconazole with intravenous micafungin bridging, POS-MIC), data from the Cologne Cohort of Neutropenic Patients (CoCoNut) study were analyzed after nearest-neighbor matching. Endpoints were occurrence of breakthrough probable/proven IFD under prophylaxis, incidence and duration of persistent febrile neutropenia, incidence of unspecific pneumonic infiltrates, possible IFD, positive galactomannan tests, as well as fungal-free and overall survival. ResultsOf 291 patients with 307 SCTs observed during the study period, 212 fulfilled the inclusion criteria and were included into the analysis. Patients receiving POS-MIC were less likely to develop a pneumonic infiltrate (RR 0.71, 95% CI 0.51-1.00) or possible IFD (RR 0.36, 95% 0.15-0.87). They also demonstrated improved fungal-free survival at day 100 (P=0.009). No significant differences were observed for the incidence of probable or proven IFD, positive galactomannan tests, persistent febrile neutropenia, duration of hospitalization and overall mortality. There was no grade III or IV CTCAE (Common Terminology Criteria for Adverse Events) toxicity related to antifungal prophylaxis. ConclusionOur results suggest that both prophylactic regimens, POS and POS-MIC are feasible, safe and effective. Our data suggest that bridging with intravenous micafungin could indeed improve exposure to antifungal prophylaxis, which may explain the reduced incidence of pneumonia and IFD in the bridging group.

Item Type:	Journal Article
Creators:	Creators Email ORCID ORCID Put Code Vehreschild, Maria J. G. T. UNSPECIFIED UNSPECIFIED UNSPECIFIED von Bergwelt-Baildon, Michael UNSPECIFIED UNSPECIFIED UNSPECIFIED Tran, Liliane UNSPECIFIED UNSPECIFIED UNSPECIFIED Shimabukuro-Vornhagen, Alexander UNSPECIFIED orcid.org/0000-0002-2351-7294 UNSPECIFIED Wisplinghoff, Hilmar UNSPECIFIED UNSPECIFIED UNSPECIFIED Bangard, Christopher UNSPECIFIED UNSPECIFIED UNSPECIFIED Cornely, Oliver Andreas UNSPECIFIED UNSPECIFIED UNSPECIFIED Vehreschild, Joerg Janne UNSPECIFIED UNSPECIFIED UNSPECIFIED
URN:	urn:nbn:de:hbz:38-424808
DOI:	10.1111/ejh.12368
Journal or Publication Title:	Eur. J. Haematol.
Volume:	93
Number:	5
Page Range:	S. 400 - 407
Date:	2014
Publisher:	WILEY
Place of Publication:	HOBOKEN
ISSN:	1600-0609
Language:	English
Faculty:	Unspecified
Divisions:	Unspecified
Subjects:	no entry
Uncontrolled Keywords:	Keywords Language INVASIVE FUNGAL-INFECTION; ANTIFUNGAL THERAPY; AMPHOTERICIN-B; FLUCONAZOLE; RECIPIENTS; TRIAL; VORICONAZOLE; PREVENTION; EXPERIENCE Multiple languages Hematology Multiple languages
URI:	http://kups.ub.uni-koeln.de/id/eprint/42480